What Pwrcentage Of Skin Lesions Are Melanoma In Kids
INTRODUCTION
Melanoma is a rare diagnosis in the pediatric population accounting for 3% of all pediatric cancers ane ; approximately 2% of all melanomas are reported in patients under 20 years of historic period and 0.iii–0.4% of these occur in the prepubertal group (less than 12 years of age). 2 Due to its rarity and diagnostic challenges, pediatric patients may exist expected to present with poorer prognostic features. 3 Melanoma may exist atypical in children and does not ever follow the ABCD (asymmetry, border irregularity, color variability, and diameter > 6 mm) diagnostic criteria that are indicative in developed cases. 4 Cordoro et al. 5 concluded that 60% of children 0–10 years erstwhile and diagnosed with melanoma did not meet the common melanoma detection criteria just nigh often presented with amelanosis, haemorrhage, raised papulonodular primary lesions, uniform color, variable diameter, and de novo evolution.
Risk factors for babyhood melanoma include built nevi, dysplastic nevi, and familial atypical nevus syndrome. vi Total torso nevus count is thought to be an important risk gene. vii , eight Children with xeroderma pigmentosum or those receiving immunosuppressive therapy are known to besides be at greater risk. nine Regardless of gamble factors, principal melanoma arises straight from melanocyte transformation or in precursor lesions. 10
Forerunner lesions are of nifty importance to plastic surgeons because they are often the subjects of consultation, peculiarly congenital nevi. The likelihood that a particular nevus will develop into melanoma may be a deciding factor in its removal.
Melanomas in children may accept the capacity to abound more than rapidly than those in adults and to metastasize widely and precipitate death. iv Beneficial lesions like Spitz nevi have been confused with melanoma 11–13 and may delay correct diagnosis. In whatever malignancy, prognosis is more encouraging when illness is treated early but less optimistic when patients present with advanced disease. iii
This study analyzes melanoma diagnosed in childhood in British Columbia (BC) over a 35-twelvemonth period. The province's population-based cancer registry allowed us to certificate truthful incidence and outcome. Secondarily, we hoped to increment awareness of the beingness of pediatric melanoma to improve early diagnosis, treatment, and prognosis when it does appear.
METHODS
Nosotros received approval and a waiver of consent for this retrospective study (UBC C&W Research Ideals Board H14-01234).
Eligibility Criteria
Eligible subjects were younger than xviii years when diagnosed with melanoma in BC from May one, 1979, to April xxx, 2014. The definition of melanoma used in this written report was based on the International Classification of Diseases for Oncology codes 8720–8790. Information were collected from 3 sources: the BC Cancer Agency (BCCA) database, the BC Children'southward Hospital (BCCH) Discharge Database, and the BCCH Oncology Database.
Database Descriptions
BCCA is the agency responsible for the BC Cancer Registry, which collects data and provides cancer statistics for the BC population and serves as a source of information for research. BC has legislation in place that makes the reporting of cancer to the BC Cancer Registry mandatory. xiv Nosotros had admission to the data nerveless up to 2012.
The BCCH Belch Database records data from charts of patients who have undergone treatment at BCCH. Data were bachelor from 1984 onward.
The BCCH Oncology Database specifically includes simply (and all) patients treated in the hospital's Sectionalization of Oncology since 1997; this gave us more detailed information for certain patients.
Eligible patients were identified if they appeared in any of these databases. Their data were compiled for assay and duplicates were merged.
Data and Analysis
Data collection included patient demographics, details of diagnosis, handling administered, and outcome. The information were analyzed with descriptive statistics. Statistically significant differences between the incidence of melanoma in prepubertal versus postpubertal historic period were tested by Pearson chi-foursquare test, and the difference between the subgroups was tested by Fisher verbal probability test.
RESULTS
Lxx-5 cases were identified from the BCCA database, 20 from the BCCH Discharge Database, and 6 from the BCCH Oncology Database. After eliminating duplicates and ineligible subjects (nonmelanoma), a cohort of 78 subjects remained. Characteristics of the patient population (n = 78) tin be constitute in Tabular array 1. Ethnicity data were not recorded in any of the databases.
Patient Characteristics
The number of new pediatric melanoma cases diagnosed in children anile 0–17 years averaged i.97 per year during the report catamenia in the province of BC. According to Population BC statistics, the mean population of children 0–17 years in BC during the study period was estimated to be 846,425, making the incidence of melanoma 2.36 per ane,000,000 per year. No gross increase in incidence in pediatric melanoma was observed over the written report period with forty patients diagnosed in the first half and 38 in the second half (Fig. ane). In the same period of fourth dimension, melanoma was diagnosed in 20,975 of the BC adult population (estimated 3,111,330), accounting for an incidence of 193 per 1,000,000 per year. Therefore, cases of melanoma diagnosed in children correspond 0.37% of melanoma incidence overall. Reassuringly, prepubertal cases in this study stand for a mere 0.08% of all melanomas diagnosed in BC.
Pediatric patient status (alive or deceased) with reference to the twelvemonth of diagnosis.
The mean age at diagnosis was 13.3 years, with 17 children (21.8%) diagnosed at age 11 or younger (our proxy for prepubertal age) and 61 children (78.2%) at 12–17 years (postpubertal). The comparing of the incidence of pre- and postpubertal melanoma cases (17 and 61) calculated from the same-age population in BC (547,416 and 299,009, respectively) showed statistically significantly lower incidence in the prepubertal (0.09 per 100,000 per year) versus postpubertal (0.58 per 100,000 per twelvemonth) cases (P < 0.0001). There were six cases of prepubertal melanoma in the first half of the examined fourth dimension frame (1979–1996) and 11 cases in the second half (1997–2014). In the postpubertal grouping, 34 cases occurred in the beginning half and 27 cases occurred in the latter half of the study period. Although the number of prepubertal melanoma almost doubled in the second half of the study period, in that location was no statistically pregnant deviation in incidence compared with the postpubertal group (P = 0.xi).
At that place was no difference in incidence by sex (M = 38, F = xl) within the written report group. The mean pediatric male population over the study catamenia in BC was 435,766 and female 410,659, and then there was also no difference constitute in population-based melanoma incidence (P = 0.71). Similarly, the sexual activity distribution was balanced in the prepubertal (Yard = 9, F = 8) and the postpubertal group (M = 29, F = 32). The Grand:F ratio according to the sites of main occurrence was extremities 13:20, torso fourteen:xiii, face and scalp 8:two, and ocular ii:5, with no statistically significant divergence (P = 0.ten).
Of the 12 deaths that occurred in the study population, all were attributed to melanoma and all but 1 occurred in children diagnosed at 11 years of age or older (Fig. 2). Ten were a result of cutaneous melanoma, i of ocular melanoma, and 1 was a result of primary melanoma of the primal nervous arrangement (CNS). The latter case was a prepubertal patient with neurocutaneous melanosis (simply with only a CNS component), which transformed into melanoma and a fatal outcome 3 months after diagnosis. Excluding this patient, the mean fourth dimension between the date of diagnosis and the date of expiry was 9 years and 4 months, with a minimum of one twelvemonth and half dozen months and a maximum of 19 years and 11 months. With this lag time, bold the death charge per unit remains the same, we may predict up to two farther fatalities among the cases diagnosed within the past 11 years. The locations of melanoma were extremities (northward = 33), trunk (n = 27), face up/scalp (n = 10), ocular (n = 7), and CNS (northward = one; Fig. 3). Of the cutaneous lesions, melanoma occurring on the torso resulted in the highest mortality rate (22.2%; Fig. four).
Current patient status (alive or deceased) with reference to their age at diagnosis with melanoma.
Sites of primary occurrence.
Patient status with reference to site of occurrence.
The virtually common histotypes reported at diagnosis in this population are outlined in Figure 5. Xc percent of the superficial spreading melanomas occurred in the postpubertal historic period group. In 36 cases, melanoma histotype was unspecified (not otherwise specified [NOS]); we did non have the power to request review of the pathological slides. 1 case of malignant transformation within a congenital nevus was documented, but nosotros cannot assume that at that place are no congenital nevi within the NOS group. Unfortunately, the clinical provenance of melanoma was not included comprehensively in any of the databases.
Classification of melanoma at diagnosis, according to International Classification of Diseases for Oncology, 3rd edition.
Handling beyond excisional biopsy included chemotherapy, radiotherapy, further surgery, or a combination thereof (Fig. vi). Viii patients treated with chemotherapy and 7 treated with radiotherapy eventually died.
Treatment beyond excisional biopsy. CT, chemotherapy; RT, radiotherapy; SX, farther surgery). *This patient was a half dozen-year-old child with neurocutaneous melanosis, which transformed into malignant melanoma of the CNS resulting in a fatal issue 3 months afterward the diagnosis.
Staging at diagnosis, sentinel node biopsy, and excisional biopsy margin data were limited or unavailable for analysis.
The distribution of melanoma across unlike regions of BC does non seem representative of the relative population size in each location. The incidence in children aged 0 to 17 years per region ranged from 0.eight to 28.4 per million (Fig. vii).
Distribution of pediatric melanoma in BC. Source: BC Stats. British Columbia Schoolhouse Districts, 2008. Reproduced and adapted with permission of the Province of British Columbia. Adaptations are themselves works protected past copyright. And so in club to publish this accommodation, authorization must be obtained both from the owner of the copyright in the original work and from the possessor of copyright in the translation or adaptation.
DISCUSSION
This is the kickoff review of pediatric melanoma in BC. Reviews of this kind performed in other geographic locations (the United States, three , 15 Sweden, 16 and Australia 17 ) take shown increases over time in the incidence of pediatric melanoma. Over a 35-year time menstruation in BC, nosotros plant no trend toward increasing incidence and also constitute that the number of cases remained exceedingly small. Many surgeons take referred patients with worrisome skin lesions, but it may be reassuring to note that in our population, melanoma arising in childhood (1 in ~425,000 children) is an club of magnitude less frequent than the rarest of rare inborn errors of metabolism.
Similarly, we could not decide a human relationship between the calendar year of patient's diagnosis and his or her current status. The 11 diagnoses that eventually resulted in decease occurred evenly in the commencement and 2d half of the 35-year time span. There is a lag time averaging 9 years from diagnosis to death, which prevents us from forming conclusions nigh improvement in prognosis.
Contrary to results found in the literature, sixteen , eighteen , 19 our population showed no meaning sexual activity-related trends in incidence. Although 20 of 33 cases (60%) occurring on the extremities (upper and lower limbs) presented in female person patients, this was not statistically significant. Even so, the trend of these data may concur with the findings past Strouse et al. 3 who attribute this to the practice of sunbathing or indoor tanning popular amongst young females.
In the fourth dimension menstruum examined, pediatric cases of melanoma represent 0.37% of the melanoma cases overall with the prepubertal cases making upward only 0.08%. These values are lower than others published in the literature (2% and 0.3–0.4%, respectively). 2 , 20–24 This could exist attributable to our study location having a greater distance from the equator or compared with countries with similar latitudes, a population with greater geographic or indigenous variability. Increased ultraviolet exposure is a well-established adventure factor for developing melanoma in adults 25 ; all patients in this report resided within the breadth range 48.42–54.52, and this area would exist expected to experience less ultraviolet exposure than a population examined in the United States or Australia but non Sweden. In a pediatric population, especially the prepubertal group, it may seem obvious that environmental exposures may be less of a contributing run a risk gene, although babyhood may also exist the time of nigh frequent outdoor activeness. In the evolution of benign nevi, sunlight has a prominent role, merely their formation is also under genetic control. 26 , 27 A contempo twin study in adults suggests that total body nevus count may exist the best predictor of melanoma risk (the nevus count on i arm was used to estimate the total body nevus count) and tin be used to judge melanoma risk in full general practice. 31 We do not take the nevus count data of our patient population, nor do we accept conclusive evidence that nevus count related to age in pediatric patients is correlated with pediatric melanoma. This may be a focus for further study.
Twelve children died from melanoma over the fourth dimension period. Of the 10 deaths that were attributed to cutaneous melanoma, 9 occurred in what nosotros take assigned as the postpubertal historic period group; withal, because the overall numbers of diagnoses were higher postpubertally, the mortality rate was non statistically significantly different. We chose 11 years as a proxy indicator of the end of prepuberty, but we cannot confirm that the patient diagnosed at age eleven, and therefore included in our prepubertal group, was in fact prepubertal physiologically. Significantly, there have been no deaths from cutaneous melanoma diagnosed earlier age 11.
Malignant melanoma is second only to thyroid cancer in the types of adult cancers seen in children. 29 Melanoma in the postpubertal age grouping tends to human activity like adult melanoma thirty and may be more likely to metastasize, resulting in poorer prognosis and increased fatality. We cannot conclude that treatment in the younger grouping may be more curative, but we also cannot rule this out. Excision of a suspicious nevus is recommended regardless of human relationship to puberty, just afterwards puberty, hormonal changes are thought to enhance development of melanoma. 31 We were unable to glean from any of the databases the denominator of cases arising from congenital nevi.
The increased incidence of melanoma in certain geographical areas may not be truly representative due to the minor population size. Our study was unable to conclude anything about the human relationship between patients and geographical location or the ethnicity of patient or regional populations.
Of the eighteen patients who received radiation and/or chemotherapy, 11 (61%) died. It is probable that the patients who were given these forms of handling presented with a more advanced form of the disease and had a poorer prognosis even at the time of diagnosis. The small number of patients who received chemotherapy all received individually different protocols; no conclusions can exist drawn about effectiveness of treatment.
Every bit an illustrative case of prepubertal melanoma and course of treatment, i of the patients in this report was diagnosed and treated for melanoma at the age of iii. The male subject field presented with ii congenital nevi at nativity: 1 on the left scalp (dime sized and calorie-free brown in color with dark heart area) and another on the correct inguinal region (lite brown in colour). At 6 months, the scalp lesion began to grow in height. Trauma to the area would occasionally cause bleeding and the wounds that resulted would often have healing delay. He was seen past a plastic surgeon in his community at the age of twenty months who felt the lesion was likely an singular hemangioma and that there was a low risk of malignancy. As time went on and ulceration became more than persistent, the possibility of neoplasia was entertained. At the historic period of three years and ix months, the lesion was biopsied with narrow margins by the same plastic surgeon and the pathologist thought information technology was a spitz nevus with unusual features just could not rule out melanoma. A review of the slide past a quaternary dermatopathologist inverse its diagnosis to melanoma, nodular type, 4.5-mm depth, and Clark level IV with ulceration. A referral to a BCCH pediatric plastic surgeon was fabricated and wide local excision (two cm) with sentinel lymph node biopsy (jugular concatenation) and pare graft reconstruction was undertaken within 9 days of referral. The broad excision pathology reported no balance lesion in the specimen, and all three nodes were negative for metastatic melanoma. PET-CT and CT browse of lungs showed no evidence of distant disease, and a follow-up PET-CT 2 years subsequently too was negative. The congenital nevus of the inguinal region was also completely excised with narrow margins but showed no prove of malignancy. The patient was followed up by an oncologist but given no coincident treatment and had no further recurrence of the melanoma as of the age of 6 when he moved from the province. In this case, treatment was provided by the appropriate specialists and administered in a timely mode one time enough suspicion was caused, but there was a significant lag time to initial biopsy that may do good from education about how these malignancies may nowadays and so differently in young children.
Prompt treatment has been shown to be important in melanoma in general. Because pediatric melanoma may non always present the same way as information technology does in adults, it is important to be on the spotter for unusual presentations across the ABCD diagnostic criteria that are used in an adult clinical setting. Specific ABCD diagnostic characteristics have even been suggested for melanoma in children: Amelanotic; Bleeding, Bump; Color uniformity; De novo, whatsoever Diameter. 5 Suspicion of melanoma warrants referral to a specialist for biopsy; in younger children, a pediatric specialist may accept easier access to pediatric anesthesia and imaging, if required, and other specialist follow-up.
LIMITATIONS
This was a retrospective study limited by the scope of data collected in the BCCA database. Overall death rate might be underrepresented due to the lag time between diagnosis and eventual death (hateful of 9 years and iv months). Applying the mean expected death rate over the past 11 years of data, we may expect some other 2 fatalities in our cohort. Pathologic diagnosis of melanoma in children is sometimes controversial, and many specimens are sent for second pathology opinions. We exercise not take access to data that reveal the extent of whatever controversial diagnoses.
CONCLUSIONS
Melanoma in British Columbian children remains exceedingly rare with an incidence of ii.36 per 1000000 per year in ages 17 and under. Within the group, incidence is college in those anile 12 years and over, and in the 35-yr report period, no children with cutaneous melanoma died of disease diagnosed earlier the historic period of 11. We cannot brand conclusions about the risk of melanoma within built cutaneous lesions, or their lifetime take a chance, though because the prevalence of congenital nevi in the pediatric population and the low rate of melanoma diagnosis, urgent removal of clinically stable congenital nevus may exist indicated only rarely. We plant no trends showing potential association with ethnicity or latitude. We plant no trend in incidence, patient factors, or prognosis over the 35 years of our study.
The presentation of melanoma in younger patients may be atypical and not high on the list of differential diagnoses of unusual lesions in children, fifty-fifty to plastic surgeons. One of the goals of this study was to bring not only awareness of the existence of pediatric melanoma to primary healthcare providers but also reassurance that the diagnosis remains rare.
ACKNOWLEDGEMENT
The authors would like to thank Iris Liu for her piece of work on the British Columbia School Commune Epitome adaptation (Figure 7).
REFERENCES
1. Han D, Zager JS, Han Yard, et al. The unique clinical characteristics of melanoma diagnosed in children. Ann Surg Oncol. 2012;xix:3888–3895.
ii. Ferrari A, Bono A, Baldi M, et al. Does melanoma conduct differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics. 2005;115:649–654.
iii. Strouse JJ, Fears TR, Tucker MA, et al. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol. 2005;23:4735–4741.
4. Mones JM, Ackerman AB. Melanomas in prepubescent children: review comprehensively, critique historically, criteria diagnostically, and class biologically. Am J Dermatopathol. 2003;25:223–238.
5. Cordoro KM, Gupta D, Frieden IJ, et al. Pediatric melanoma: results of a big cohort report and proposal for modified ABCD detection criteria for children. J Am Acad Dermatol. 2013;68:913–925.
half dozen. Schmid-Wendtner MH, Berking C, Baumert J, et al. Cutaneous melanoma in childhood and adolescence: an analysis of 36 patients. J Am Acad Dermatol. 2002;46:874–879.
7. Garbe C, Büttner P, Weiss J, et al. Associated factors in the prevalence of more than 50 common melanocytic nevi, atypical melanocytic nevi, and actinic lentigines: multicenter case-control study of the Central Malignant Melanoma Registry of the German Dermatological Order. J Invest Dermatol. 1994;102:700–705.
viii. Gandini S, Sera F, Cattaruzza MS, et al. Meta-assay of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41:28–44.
nine. Kraemer KH, Lee MM, Scotto J. Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 830 published cases. Arch Dermatol. 1987;123:241–250.
10. Mills O, Messina JL. Pediatric melanoma: a review. Cancer Control. 2009;16:225–233.
eleven. Barnhill RL. The Spitzoid lesion: rethinking Spitz tumors, atypical variants, 'Spitzoid melanoma' and risk cess. Mod Pathol. 2006;19(suppl 2):S21–S33.
12. Barnhill RL, Argenyi ZB, From Fifty, et al. Atypical Spitz nevi/tumors: lack of consensus for diagnosis, bigotry from melanoma, and prediction of outcome. Hum Pathol. 1999;30:513–520.
13. Barnhill RL, Flotte TJ, Fleischli Chiliad, et al. Cutaneous melanoma and atypical Spitz tumors in childhood. Cancer. 1995;76:1833–1845.
14. von Tigerstrom B, Ries NM. Cancer surveillance in Canada: assay of legal and policy frameworks and tools for reform. Health Law J. 2009;17:1–49.
- Cited Hither |
- PubMed
15. Austin MT, Xing Y, Hayes-Jordan AA, et al. Melanoma incidence rises for children and adolescents: an epidemiologic review of pediatric melanoma in the United States. J Pediatr Surg. 2013;48:2207–2213.
16. Karlsson P, Boeryd B, Sander B, et al. Increasing incidence of cutaneous malignant melanoma in children and adolescents 12-nineteen years of age in Sweden 1973-92. Acta Derm Venereol. 1998;78:289–292.
17. Whiteman D, Valery P, McWhirter Westward, et al. Incidence of cutaneous childhood melanoma in Queensland, Australia. Int J Cancer. 1995;63:765–768.
18. Averbook BJ, Lee SJ, Delman KA, et al. Pediatric melanoma: analysis of an international registry. Cancer. 2013;119:4012–4019.
19. Berk DR, LaBuz E, Dadras SS, et al. Melanoma and melanocytic tumors of uncertain cancerous potential in children, adolescents and young adults--the Stanford experience 1995–2008. Pediatr Dermatol 2010;27:244–254.
20. Ruiz-Maldonado R, Orozco-Covarrubias ML. Malignant melanoma in children. A review. Arch Dermatol. 1997;133:363–371.
21. Bader JL, Li FP, Olmstead PM, et al. Childhood malignant melanoma. Incidence and etiology. Am J Pediatr Hematol Oncol. 1985;seven:341–345.
22. Boddie AW Jr, Smith JL Jr, McBride CM. Malignant melanoma in children and immature adults: consequence of diagnostic criteria on staging and end results. South Med J. 1978;71:1074–1078.
23. Conti EM, Cercato MC, Gatta M, et al.; EUROCARE Working Group. Childhood melanoma in Europe since 1978: a population-based survival report. Eur J Cancer. 2001;37:780–784.
24. Saenz NC, Saenz-Badillos J, Busam Thousand, et al. Childhood melanoma survival. Cancer. 1999;85:750–754.
25. Bauer J, Garbe C. Acquired melanocytic nevi every bit adventure factor for melanoma evolution. A comprehensive review of epidemiological data. Paint Cell Res. 2003;xvi:297–306.
26. Bataille V, Snieder H, MacGregor AJ, et al. Genetics of risk factors for melanoma: an adult twin study of nevi and freckles. J Natl Cancer Inst. 2000;92:457–463.
27. Wachsmuth RC, Turner F, Barrett JH, et al. The effect of sunday exposure in determining nevus density in UK adolescent twins. J Invest Dermatol. 2005;124:56–62.
28. Ribero S, Zugna D, Osella-Abate South, et al. Prediction of high naevus count in a healthy U.K. population to estimate melanoma chance. Br J Dermatol. 2016;174:312–318.
29. Rao BN, Hayes FA, Pratt CB, et al. Malignant melanoma in children: its management and prognosis. J Pediatr Surg. 1990;25:198–203.
thirty. Coit DG, Ernstoff MS, Busam KJ. Is pediatric melanoma always cancerous? Cancer. 2013;119:3910–3913.
31. Pack GT, Gerber DM, Scharnagel IM. End results in the treatment of malignant melanoma; a report of 1190 cases. Ann Surg. 1952;136:905–911.
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